Vitreous Hemorrhage

Aka: Vitreous Hemorrhage

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II. Pathophysiology

  1. Most commonly caused by Diabetic Retinopathy, Eye Trauma or Posterior Vitreous Detachment
  2. Mechanisms
    1. Normal blood vessel rupture (e.g. Eye Trauma, Vitreous Detachment, Shaken Baby Syndrome)
    2. Pathologic structure bleeding (e.g. neovascularized Retina in Diabetic Retinopathy, CRVO)

III. Risk Factors

  1. Diabetes Mellitus (Diabetic Retinopathy)
  2. Coagulopathy
  3. Retinal Tear (from Posterior Vitreous Detachment)
  4. Proliferative sickle Retinopathy (Sickle Cell Anemia)
  5. Eye Trauma
  6. Macular Degeneration
  7. Retinal artery micro-aneurysm
  8. Shaken Baby Syndrome
  9. Central Retinal Vein Occlusion (CRVO)
  10. Terson Syndrome (associated with Subarachnoid Hemorrhage)
    1. Occurs in 20-30% of SAH cases, and is associated with a worse prognosis
  11. Coagulopathy
    1. Thrombocytopenia
    2. Idiopathic Thrombocytopenic Purpura
    3. Hemophilia
    4. Leukemia

IV. Symptoms

  1. Acute Vision Loss lasting for minutes to hours
    1. Visual Floaters or "cobwebs"
    2. Red visual hue
    3. Often worse in the morning after the blood has settled over the Macula

V. Signs

  1. Funduscopy
    1. Red Haze of Fundoscopy obscures the Retina
  2. Pupil reflex
    1. Normal (consider Retinal Detachment if abnormal pupil reflex)
  3. Slit Lamp
    1. Evaluate for Red Blood Cells in anterior chamber

VI. Imaging

  1. Ocular Ultrasound
    1. May reveal Vitreous Hemorrhages

VII. Management

  1. Urgent ophthalmology evaluation within 24 hours
    1. Panretinal photocoagulation (for proliferative photocoagulation)
    2. Pars Plana Vitrectomy (Retinal Detachment)
  2. Bedrest
  3. Elevate head of bed to 30 degrees
  4. Hold Anticoagulants if possible (including Aspirin and NSAIDs)
  5. Avoid strenuous activity (that might increase Blood Pressure and worsen spontaneous bleeding)

VIII. Management

  1. Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11

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Ontology: Vitreous Hemorrhage (C0042909)

Definition (NCI_CTCAE) A disorder characterized by blood extravasation into the vitreous humor.
Definition (NCI) Blood extravasation in the vitreous humor. Causes include neovascularization, retinal tear, retinal detachment, and rupture of a blood vessel aneurysm in the eye.
Definition (MSH) Hemorrhage into the VITREOUS BODY.
Concepts Pathologic Function (T046)
MSH D014823
ICD9 379.23
ICD10 H43.1 , H43.10
SnomedCT 31341008
English Hemorrhage, Vitreous, Vitreous Hemorrhages, VITREOUS HEMORRHAGE, VITREOUS HAEMORRHAGE, Vitreous Hemorrhage, vitreous hemorrhage (diagnosis), vitreous hemorrhage (physical finding), vitreous hemorrhage, Blood In Vitreous Fluid, Vitreous hemorrhage, unspecified eye, Vitreous Hemorrhage [Disease/Finding], vitreous haemorrhage, vitreous hemorrhages, disorder vitreous hemorrhage, hemorrhage vitreous, Vitreous bleeding, Vitreal hemorrhage, BLOOD IN VITREOUS FLUID, FLUID, BLOOD IN VITREOUS, VITREOUS FLUID, BLOOD IN, Vitreous hemorrhage, Intragel vitreous haemorrhage, Intragel vitreous hemorrhage, Vitreous haemorrhage, Vitreous hemorrhage (disorder), hemorrhage; vitreous body, vitreous body; hemorrhage, VH - Vitreous haemorrhage, VH - Vitreous hemorrhage
Italian Emorragia vitreale, Sanguinamento del corpo vitreo, Emorragia del corpo vitreo
Swedish Glaskroppsblödning
Japanese ｼｮｳｼﾀｲｼｭｯｹﾂ, 硝子体出血, 出血-硝子体
Czech sklivec - hemoragie, Sklivcová hemoragie, Sklivcové krvácení, Krvácení do sklivce
Finnish Lasiaisverenvuoto
Russian KROVOIZLIIANIE V STEKLOVIDNOE TELO, STEKLOVIDNOGO TELA GEMORRAGIIA, КРОВОИЗЛИЯНИЕ В СТЕКЛОВИДНОЕ ТЕЛО, СТЕКЛОВИДНОГО ТЕЛА ГЕМОРРАГИЯ
Portuguese HEMORRAGIA DO VITREO, Sangramento do vítreo, Hemorragia no vítreo, Hemorragia Vítrea
French HEMORRAGIE DU VITRE, Saignement du corps vitré, Hémorragie du corps vitré, Hémorragie du vitré, Hémorragie intra-vitréenne, Hémorragie vitréenne
Korean 유리체 출혈
Polish Krwotok do ciała szklistego
Hungarian Üvegtesti vérzés, Üvegtest vérzés
Dutch bloeding van glasvocht, bloeding; corpus vitreum, corpus vitreum; bloeding, glasvochtbloeding, Bloeding van het corpus vitreum, Bloeding, glasvocht-, Glasvochtbloeding
German Bluten des Glaskoerpers, Glaskoerperblutung, Blutung, Glaskörper-, Glaskörperblutung, Hämorrhagie, Glaskörper-
Spanish Sangrado del vítreo, hemorragia vítrea (trastorno), hemorragia vítrea, Hemorragia del vítreo, Hemorragia Vítrea
Norwegian Blødning til corpus vitreum, Blødning til glasslegemet, Corpus vitreum-blødning, Glasslegemeblødning, Vitreus blødning, Vitreus hemoragi, Glasslegemehemoragi
Derived from the NIH UMLS (Unified Medical Language System)

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